Concussions & Sports–Legal & Ethical Review: Part 1

Alan Schwarz, award-winning National Correspondent for the New York Times who authored the introduction to The Journal of Law, Medicine & Ethics1 “Concussion and Sports” special issue, cites the almost nonsensical way in which we’re dealing with the problem of concussions in American sports. “The vast majority of organized football games among children are played with no doctor or athletic trainer present,” writes Schwarz, “the explanation always being, ‘We don’t have the money to pay for one.’ But this is stunningly untrue—they do have the money, they just choose to spend it on a defensive line coach.”

Schwarz also notes that these same youth football organizers seem satisfied with meeting mandatory safety guidelines that are often dangerously outdated. Doing the bare minimum to live up to the regulations trumped the true cost of outfitting their kids with the latest, most protective gear.

“The issue of concussions in sports is a very difficult one,” says Schwarz. “Of course it involves law, medicine, and ethics. And my goodness, so many dollars. But what exposed the problem was demanding that people make sense, and that’s what will fix it, too.”

A major obstacle in dealing with sports concussions, particularly on the youth level, is a simple lack of information. “One major difficulty in collecting data on which to base injury prevention strategies is the lack of large epidemiologic studies and comprehensive injury surveillance systems for youth sports,” writes Dr. Kevin D. Walter for the American Medical Association.2 There are existing injury surveillance systems in place, but each is uniquely limited.

Dr. Walter notes another problem in generating effective safety guidelines, one which is more difficult to solve: players’ tendency to under-report their injuries. “A 2004 study by McCrea showed that only 47.3 percent of affected athletes reported a concussion. Many of these athletes felt a concussion was not serious enough to warrant reporting and said they did not want to be withheld from competition.”

Another problem: in the event that we manage to formulate best-practices recommendations, implementation presents major obstacles. This is due to the fact that there is no central oversight of many of the sports.

These problems, though, must be solved. The issue of sports concussions has quickly expanded beyond a mere concern. In the words of some medical commentators, concussions in sports can now rightly be called an epidemic.